TB is blamed for two million deaths every year. Most of them are in developing countries. It’s also the second leading cause of death among infectious diseases.

Over the years, TB and HIV have been closely linked because TB easily infects those with weakened immune systems. Also, new drug resistant strains of TB have arisen, often making treatment difficult and painful and sometimes ineffective.

But a study in Togo reports a 10 percent drop in TB deaths following changes in services in the Lacs Health District. It’s located in the country’s southern Maritime Region.

Dr. Kossivi Afanvi works for Togo’s Ministry of Health. He was health director of the Lacs District from 2008 to 2015. He said when he arrived there was much room for improvement in the treatment of TB.

“The treatment rate of tuberculosis was very, very low at 80 percent. And the death rate was very, very high at 13 percent.”

Afanvi is the lead author of the Togo study appearing in BMJ Quality Improvement Reports. He had received training from the Boston-based Institute for Healthcare Improvement, a non-profit organization. In 2012, Afanvi implemented – what’s called -- a System Quality Improvement Model in Lacs.

“So, we decided to increase the treatment success rate to at least 85 percent and to reduce the mortality rate to five percent,” he said.

Two years later, the program exceeded its goals. The mortality rate quickly fell from 13 to three percent. And by the time he took a new job early this year, he said there were no TB deaths in Lacs District.

There’s a hospital and more than 30 health clinics in Lacs. The model called for increasing TB screening in every location where there was a registered nurse. If a test is positive, it’s followed by intensive treatment.

What’s more, screening was also done for HIV. Treating those infected with the AIDS virus can strengthen their immune systems and in turn make them better able to defend against TB.

Dr. Afanvi is now in charge of the neighboring Vo Health District, where he’s also implemented the System Quality Improvement Model.

“In my new district, I decided to use the model to manage other programs. I came here in February and according to the immunization program the rate was at 75 [percent].But actually we are at 91 [percent] for vaccinating or immunizing children,” he said.

And the TB death rate has also dropped sharply in Vo.

Afanvi has recommended to Togo’s Ministry of Health that the model be applied to the entire country. He’s working on a doctorate on public health using the quality improvement model. Dr. Afanvi is also seeking a fellowship at the Institute for Healthcare Improvement.